INTRODUCTION
Anyone who has protruding ears has experienced self-consciousness and possibly ridicule or teasing about this problem as a child. The ideal time for surgery is just before school starts, at age 5, when most of the ear development has already occurred. However, many patients make it into adulthood without having their protruding ears corrected.
What Causes the Ears to Stand Out?
The ears stand out because their development in the uterus was not finished. The last step—the ears folding back—did not happen. Fortunately, plastic surgical correction is very effective.
Surgery Requires Finesse
A setback otoplasty is not an easy procedure. It takes considerable attention to detail on the part of the surgeon to avoid telltale signs of surgery and to prevent overcorrection, so that the ears don’t look like they are stuck to the sides of the head. The incision is hidden in the crease behind the ear. The surgery is not painful and, in experienced hands the complication rate is low.
PHOTOS OF PATIENTS WITH EAR SURGERY
M.M., Age 17
Procedure: Setback otoplasty
Before, 6 weeks after
D.C., Age 48
Procedure: Setback otoplasty, facelift, chin/jowl implant, fat injection (18 cc.)
Before, 3 months after
Earlobe Reduction
A.S., Age 55
Procedure: Earlobe Reduction
Before, 2 months after
T.S., Age 25
Procedure: Setback otoplasties.
Before, 1 month after
B.E., Age 27
Procedure: Setback otoplasty
Before, 1 month after
Repair of Gauged Ears
A.L., Age 35
Procedure: repair of gauged earlobes
Before, 5.5 months after
B.S., Age 37
Procedure: Setback otoplasty
Before, 1 month after
The surgery is done with the patient asleep under intravenous sedation. An incision is made in the crease (“postauricular”) behind the ear. The cartilage is exposed. A fold is created using sutures that fold the cartilage on itself. As these sutures are tied down, the surgeon judges the degree of correction. The placement of the sutures is adjusted to achieve just the right amount of folding and just the right degree of ear projection while avoiding any undue crimping of the border of the ear.
Intraoperative photograph of setback otoplasty.
The suture is being tied, creating the fold in the cartilage. When the right amount of folding is obtained, the suture is tied down.
The incision is hidden in the crease behind the ear.
Before-and-after photographs of this patient are shown in the Before and After patient photographs section (M.M.).
For setback otoplasty, a wraparound head dressing is used to protect the ears for about a week. There should be minimal discomfort. The incisions are tucked behind the ears where they are well-hidden.
Under-correction
The ears may still stick out a little.
Overcorrection
The ears may be folded back too far, so they are touching the scalp behind the ear. This is not a natural look and should be avoided. Ideally, it should be possible to see some of the outside border of the ear (“helical rim”) when looking straight-on at the patient.
Scarring
The scar tends to heal well and is inconspicuous.
Recurrence
The deformity may recur, even when permanent sutures are used. Occasionally, a second operation may be needed.
Asymmetry
The ears are usually asymmetrical to start with. Like any bilateral plastic surgery procedure, perfect symmetry is not practical and cannot be expected. Fortunately, small degrees of asymmetry are well-tolerated in the ears and are unlikely to bring attention.
Persistent Suture
Occasionally, the end of a suture may protrude in the crease behind the ear. It can simply be trimmed.
Infection
Infection is a rare complication because of the ear’s excellent blood supply.
Getting Back to Normal
- A wraparound head dressing is worn for up to a week to protect the ears. This comes off in the office on the day after surgery. You are then shown how to reapply it yourself at home. You can leave it off during the day if you wish, but it is best to wear a dressing at night for a week. When it is off you can shower and shampoo your hair.
- Usually there is minimal pain. If there is excessive discomfort, especially on one side, this is reason to notify the doctor. Pain may signal a hematoma that requires urgent treatment. Fortunately, this is rare.
- Head elevation for the first couple of nights at home helps to minimize swelling.
Q: Does it hurt?
A: It is almost painless.
Q: How long does the head dressing have to stay on?
A: One week. You can take it off during the day and apply it at night.
Q: Is there a possibility of the sutures coming loose so that my ears stick out again?
A. Yes, and on occasion I have reoperated to treat a recurrent deformity.